Tuesday, June 15, 2010

Colorado Springs Business Journal Publishes Provider's Quote on H.R. 3790

The Colorado Springs Business Journal published the following quote about competitive bidding from the Colorado Association of Medical Equipment Services board member Doug Coleman:

“Competitive bidding sounds reasonable on the surface - however, in its current form, it is very dangerous for patients who need home medical equipment,” Coleman said. “The program forces providers to submit unsustainable suicide bids. Only one in ten providers will be awarded a bid, so nine out of ten providers will close their businesses … the ‘winning’ bidder will not be able to survive a the bid rates that were necessary to secure the contract.”

To read the full article, visit: http://csbj.com/2010/06/14/industry-group-opposes-medicare-bidding-plan/

Tuesday, June 8, 2010

Patient Advocate Cites Benefits of Power Mobility

The American Association for Homecare published the fifth installment of Mobility Matters, a periodical which is used to inform Congress, the administration, policymakers, consumer organizations and the media about Medicare’s power mobility benefit, and the need to sustain it. Issue five reads:

For decades, Lucy Spruill has been an advocate for people living with disabilities. She has been employed at United Cerebral Palsy of Pittsburgh for eleven years as Director of the CLASS Attendant Care Program and, more recently, as Director of Public Policy and Community Relations. She served on the Board of Directors for eight years and during that time was Chair of the former Governmental Activities Committee. Ms. Spruill also served as the first ADA Coordinator for the City of Pittsburgh and has held several positions in community maternal and child health programs. Ms. Spruill, 65, has spina bifida and has needed mobility assistance for most of her life. She recently answered some questions about the challenges she has faced and those faced by Medicare beneficiaries in need of power mobility.

Q) How has a power wheelchair benefited you?
I walked with the aid of crutches for 18 years and used a manual wheelchair for 30 years before changing to power mobility. I did so because I had overuse in my shoulder muscles (rotator cuff) which caused me extreme pain when I pushed the manual chair or transferred. Once I switched to power mobility 15 years ago the pain subsided and I have had 15 more years of active life (a full time job, family and community activities, etc.) including a trip to Europe with my grown children.

Q) How important is more freedom and independence for patients once they get power mobility?
Most people who use power mobility (including myself at the time I switched) would be limited to moving about painfully and slowly in a room or two in their homes, if that. Many would be confined to bed. This would cause major health issues—respiratory decline, pressure sores, dementia or cognitive decline, depression, contractures, pain—and would probably shorten the individual’s life in addition to greatly diminishing their quality of life.

Q) What is the biggest hurdle that Medicare beneficiaries face when trying to obtain a power wheelchair?
Meeting all of the technical requirements Medicare has created to qualify for a power chair; finding funds to pay the 20% that Medicare does not pay; finding funds to pay for a backup chair or rental chair during inevitable times when the individual’s primary power chair is down for repairs.

Q) What could Medicare do to make the process easier for beneficiaries?
Medicare should be using the substantial body of medical literature which has demonstrated the usefulness of an active lifestyle in maintaining health and well-being for a longer portion of an individual’s life. Wheelchair users are like everyone else—if they are active, maintain relationships, are able to leave their homes to work, play, obtain health care, etc., they will be healthier for a longer part of their lives. Allowing the use of whatever mobility devices are needed to facilitate a healthy lifestyle would, in the long run, save Medicare money by keeping their recipients healthier.

Q) Shouldn’t the government be taking steps to increase use of power mobility since it saves taxpayer money from fewer hospital visits from falls and delays in nursing home placements?
Yes. Medicare should be supporting anything that increases a beneficiaries’ independence and healthy years of life because it saves money. Restricting an individual’s mobility so that they need more paid help from others or need to be in a restricted environment such as a nursing home, rehabilitation center, or hospital, causes Medicare to pay more money for an undesirable rather than desirable outcome.

Q) Have you come in contact with Medicare beneficiaries who need power mobility, but have not been unable to obtain it?
Yes, through friends with disabilities and in connection with my work for 10 years as the Director of a Home and Community Based Service program funded primarily by Medical Assistance, serving over 1000 persons with physical disabilities living in their own homes and needing personal assistance to remain independent in their homes.

Q) Will competitive bidding make it easier or harder for Medicare beneficiaries to obtain power mobility?
It will make it harder.

Q) Are you worried about the impact of competitive bidding?
I am worried about the impact of competitive bidding. It will reduce the number of DME providers, which is already insufficient to meet the demands of power mobility (wait times for purchase and repairs are extremely long). It will increase the likelihood that patients will get the cheapest rather than most appropriate mobility device, which will lead to difficulty using the equipment, health problems, decreased activity, safety issues, etc. By forcing patients to deal with providers who do not know them (and who may be located in another city or state), the likelihood of the patient experiencing errors in the supplying of equipment will be increased. Patients who need multiple types of equipment (respiratory equipment, mobility equipment, hospital bed, diabetic supplies, etc.) may have to deal with multiple providers. This will cause confusion on the part of the patient, lack of appropriate continuity and coordination of services, unnecessary administrative costs due to Medicare dealing with multiple providers for a single patient instead of one provider.

For more information, please visit www.aahomecare.org/mobility.

Wednesday, June 2, 2010

New Jersey Home Medical Providers Call on Congress to Preserve Homecare as an Option for Seniors and People with Disabilities

Providers of home medical equipment and services across New Jersey are proposing a fiscally responsible alternative to the mislabeled “competitive” bidding scheme currently under way in Medicare that will actually discourage competition, reduce access to care for many of the state’s 1.3 million Medicare beneficiaries, and put hundreds of New Jersey homecare providers out of business.

Home medical equipment and services include oxygen therapy, wheelchairs, inhalation drug therapy, hospital beds, and other medically required services, supplies, and equipment used in the home.

“This bidding program is something that New Jersey’s Medicare population should be gravely concerned about,” says Wendy Russalesi, executive director of the Jersey Association of Medical Equipment Services (JAMES), which represents providers of home medical equipment in the state. “If implemented, this program will do nothing more than delay access to necessary medical equipment, reduce the quality of the medical equipment provided, and place additional economic strain on the small business community of New Jersey. With the recent passage of the health reform bill, this program is now slated to encompass an alarming 80 percent of our state during the second round of bidding.”

The Medicare bidding program encourages “suicide bidding,” using economic coercion by forcing providers to submit unsustainable bids necessary to win a contract. Although Congress delayed the implementation of the selective contracting program in 2008 to allow for needed changes, the Centers for Medicare and Medicaid Services (CMS) ignored congressional intent and did not address the flaws that precipitated the delay.

“For decades, durable medical equipment providers have competed in an open market on the basis of quality,” says David Ferguson, vice president and general manager of AtHome Medical in Morris Plains, N.J. “Our differentiating factors have always been the reliability of our products, the timeliness of our service, and the expertise of our clinicians and support staff. What we observed in the 2008 program implementation, which was delayed, was nearly 90 percent of the existing providers were prevented from servicing Medicare beneficiaries. The provision of care was awarded to some firms with little or no experience servicing the local market and those who had submitted unsustainably low rates, or ‘suicide bids,’ without thought as to the whether they could sustain care, let alone quality care. In an environment with reduced competition, quality always suffers.”

The bidding process is now underway in nine metropolitan statistical areas (MSAs) in the U.S., and that process begins in 91 more MSAs next year, including three MSAs that cover 80 percent of New Jersey.

“With all of the changes the homecare sector has had to absorb over the past several years, our company has had to make some very difficult decisions regarding the services and products we can continue to offer,” states Dr. Kevin Saluck, vice president of clinical operations at Sayreville, N.J.-based Allcare Medical, and president of JAMES. “CMS has forced us down a one-way street. At the end of this street, we will be forced to offer lesser quality products, fewer services and unfortunately, a much different business model to our referrals and customers.”

“Over the course of the last three years, we have increasingly moved away from Medicare business in preparation for this bidding program,” says John Gerity, CEO of Access 2 Care in Lincoln Park, N.J. “We estimate laying off one-third to one-half of our work force if the bidding program becomes a reality. Medicare beneficiaries will have less access to quality durable medical equipment companies, many of whom will be closing their doors.”

JAMES supports H.R. 3790, a bipartisan bill in Congress that would preserve access to homecare and provide a cost-effective alternative to a misguided Medicare “competitive” bidding program for durable medical equipment. H.R. 3790 replaces the Medicare bidding program with other types of cost-savings that will reduce reimbursements to home medical equipment providers but preserve patient access to medically required equipment and services in the home.

So far, the bill has 242 cosponsors in the U.S. House of Representatives with broad bipartisan support. More than half of both the Democratic and Republican delegations in the House support the bill.

More than half of the New Jersey delegation in the U.S. House of Representatives have cosponsored the bill: Representatives Robert Andrews, Leonard Lance, Frank LoBiondo, Donald Payne, Steven Rothman, Albio Sires, and Christopher Smith.

Patient and consumer groups that support the elimination of Medicare’s “competitive” bidding program for durable medical equipment include the ALS Association, the American Association for Respiratory Care, the American Association of People with Disabilities, International Ventilator Users Network, the Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association, and Post-Polio Health International, among others.

Proponents of the Medicare bidding program for durable medical equipment have perpetuated several myths about the program. However, the reality is quite different.

To read more, visit the AAHomecare Newsroom.